Hospitals, employers navigating waters after gay marriage ruling

(Reuters/MedPage Today LLC) — Now that the Supreme Court has legalized same-sex marriage nationwide, hospitals and employers are figuring out how to navigate the healthcare implications of the decision.

One area that might be affected is hospital visitation rights. However, most of the hospitals MedPage Today spoke to said the ruling wouldn't affect their policies since they were already fairly inclusive.

For example, "Virginia Commonwealth University Medical Center is not affected by the Supreme Court's decision regarding same-sex marriage," medical center spokeswoman Carissa Etters, in Richmond, said in an email. "The medical center has a patient-centered open visitation policy that allows the patient to designate those who can visit them. This policy has been in place for several years. The patient can also designate someone who can identify visitors on their behalf. This person does not have to be family."

In terms of healthcare privacy issues, "The patient is also permitted to designate whomever they wish to share their protected health information with," Etters said. "If a patient is unconscious or incompetent to make decisions, state law says decision rights are directed to a Power of Attorney. If a patient does not have a Power of Attorney or an advanced directive, the legal next of kin becomes the decision-maker."

She added that "Since same-sex marriage was already legal in the state of Virginia, the Supreme Court ruling does not impact or change the sharing of protected health information."

A similar policy prevails at Beth Israel Deaconess Medical Center (BIDMC) in Boston. "BIDMC does not restrict, limit, or otherwise deny visitation on the basis of race, color, national origin, religion, sex, gender identity, sexual orientation, or disability," spokesman Jerry Berger wrote in an email. "All visitors may enjoy full and equal visitation privileges, consistent with the patient's (or support person's, when appropriate) preferences."

"As for personal health information (PHI), access has always been to whoever the patient authorizes, regardless of relationship," Berger said.

At Banner-University Medical Center Tucson, in Arizona, the visitation policy — which the hospital is not expecting to change in the wake of the Supreme Court decision, according to spokeswoman Katie Riley — is nearly identical to that of Beth Israel Deaconess. The policy also says that "Banner Health will ensure that all visitors enjoy full and equal visitation privileges consistent with the patient's preferences wherever possible."

For their part, employers are also mulling over whether they should change their policies regarding domestic partner benefits. A few large employers, such as Verizon, Delta Air Lines, IBM, and Corning have already said they are going to stop offering domestic partner benefits now that gay marriage will be legal everywhere, noted Bruce Elliott, manager of compensation and benefits at the Society for Human Resource Management, in Alexandria, Va.

However, Elliott added that he does not expect that to become a trend. "I do think for the most part [these companies] are the exception," he said in a phone interview. "You're still going to see other companies -- like those out in Silicon Valley -- and the majority of them offer [domestic partner] benefits because they don't want to shrink their talent pool."

There's another possible effect that the same-sex marriage ruling could have on health insurance, he noted. "I was talking to an attorney today about this, and one thing he said is that some companies ... who are vehemently against this will try to move from a self-insured model to a fully insured model to avoid complying with the ruling."

In other words, some larger employers -- which typically "self-insure" and pay their employees' actual healthcare costs themselves, and just pay an insurance company to administer the claims -- would instead go to a more traditional insurance model in which they pay premiums to an insurance company, which then pays employees' healthcare costs.

Those employers may be thinking that the insurance company they turn to may not recognize same-sex marriages, but that likely won't fly, Elliott said. "The reality is that whether you're self-insured or fully insured, you have to offer the same type of benefit -- otherwise it's discrimination against the class of employees that the Supreme Courthas already addressed," he said.

Or the companies that pursue this strategy may be thinking, "It's not our money going out the door; it's the insurance company's money, and it's not us offering the benefit, it's actually the insurance company offering the benefit," Elliott added. America's Health Insurance Plans, a trade group for health insurers, did not respond by press time to a request for comment.